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Coricidin HBP Cough & Cold

Coricidin HBP Cough & Cold is an over the counter cough preparation (available in the USA) which contains 30 mg dextromethorphan hydrobromide (DXM) and 4 mg chlorpheniramine maleate (chlorphenamine, CPM) per tablet. Because of the chlorpheniramine, Coricidin can be extremely dangerous in recreational doses. Coricidin abuse has resulted in seven (?) confirmed deaths as well as uncounted hospitalizations. Recreational use of Coricidin is strongly discouraged.

Contents

Chlorpheniramine is an antihistamine with anticholinergic effects in high doses (dry mucosa, delirium, urinary retention, blurry vision, etc.). When used in medicinal doses, the half-life of chlorpheniramine is 24 hours (at 24 hours after consumption, the body will have metabolized 50% of the consumed amount). In high doses, the half-life is probably significantly longer.

Both DXM and chlorpheniramine are metabolized by the enzyme cytochrome P450 2D6 (CYP2D6). In high doses (like those consumed with Coricidin abuse), they require much CYP2D6 to be metabolized and act as inhibitors of this enzyme. This raises the blood levels and half-life of the consumed DXM and chlorpheniramine, meaning that the adverse effects of a high amount of Coricidin are much more intense than those of an equivalent dose of chlorpheniramine. Persons with CYP2D6 deficiency metabolize DXM and chlorpheniramine very poorly and are likely to experience much worse adverse effects.

The inhibited metabolism of DXM will result in a much higher DXM to dextrorphan (DXO) ratio, similar to that seen in persons with CYP2D6 deficiency. This means a longer-lasting experience with more cognitive and psychomotor impairment, with less pleasant effects (which are caused mainly by DXO). The chlorpheniramine also adds to these effects, causing anticholinergic effects.

If used as directed to alleviate a cough, Coricidin is generally considered safe.

Recreational (high-dose) use of Coricidin can be extremely dangerous, primarily due to chlorpheniramine, which is dangerous in high doses.

All recorded lethal Coricidin victims have consumed 10 tablets (300 mg DXM and 40 mg chlorpheniramine) or less, which suggests that either a massive build-up of chlorpheniramine has taken place (because of the raised half-life and repeated use) or the victims were CYP2D6 deficient.

Chlorpheniramine reduces the seizure threshold; this can result in seizures when Coricidin is abused, because DXM also reduces the seizure threshold. This danger is especially high in epileptics or other persons with a high risk of seizures.

Other variations of Coricidin have been abused and resulted in several hospitalizations. Abuse of these non-DXM Coricidin variations probably happens only because people hear about getting high on Coricidin, without knowing anything about its active ingredients.

Coricidin is currently available without a prescription at many pharmacies throughout the United States. Some pharmacies have taken to removing the product from easy access to customers and putting it behind the counter where customers must ask for it. Some pharmacies may also check ID to ensure purchasing customers are over the age of 18.